TRANSIENT OCCUPANCY TAX FORM
Name of Establishment:
Reporting Month/Year:
Room Reporting Information
1. Number of rooms available for rent
2. Occupancy Rate
3. Number of rooms occupied by exempt persons
Worksheet for T.O.T. Levy
1. Total rent charged for occupancy of rooms $
2. Allowable deductions
a. Permanent Residents $
b. Governmental Agencies $
c. Adjustments $
3. Total Deductions (total of a, b, and c) $
4. Taxable rents (line 1 minus line 3) $
5. Total Tax Due (14% of line 4) $
(due by 30
th
of the following month)
6. Penalties (10% of line 5) $
(due within 30 days of original due date)
7. Interest (1.5% per month of the total of line 5 plus line 6) $
8. Total Payment (add lines 5 through 7) $
I certify (or declare) under penalty of perjury that the foregoing information and tax calculations are
true and correct.
Prepared by:
Name: _______________________________________
Title: _________________________________________
Signature: ____________________________________
Date: ________________________________________
Phone: _______________________________________
Email: ________________________________________
Please remit payment to:
City of Diamond Bar – Finance Department
21810 Copley Drive
Diamond Bar, CA 91765
Continued delinquency (beyond 30 days) will result in an additional 10% penalty of the unpaid tax.
